September 1st, 2017
Background - Clinical decision support (CDS) tools - with easily understood and actionable information, at the point of care - are needed to help registered nurses (RNs) make evidence-based decisions. Not clear are the optimal formats of CDS tools. Thorough, preclinical testing is desirable to avoid costly errors associated with premature implementation in electronic health records.
Objective - To determine the feasibility of the protocol for designed to compare multiple CDS formats, and evaluate effects of numeracy and graph literacy on RN adoption of best practices and care-planning time in a simulated environment.
Methods - In this pilot study, 60 RNs were randomly assigned to one of four CDS conditions (control; text; text+graph; text+table) and asked to adjust the plan of care for two patient scenarios over three shifts. A total of 14 best practices were identified for the two patients and sent as suggestions with evidence to the three CDS groups. Best practice adoption rates, care-planning time, and their relationship to the RN’'s numeracy and graph literacy scores were assessed.
Results - CDS groups had a higher adoption rate of best practices (p < .001) across all shifts and decreased care-planning time in shifts two (p = .01) and three (p = .02) compared to the control group. Higher numeracy and graph literacy were associated with shorter care-planning times under text+table (p = .05) and text+graph conditions (p = .01). No significant differences were found between the three CDS groups on adoption rate and care-planning time.
Discussion - This pilot study demonstrates the feasibility of our protocol. Findings show preliminary evidence that CDS improves the efficiency and effectiveness of care-planning decisions, and that the optimal format may depend on individual RN characteristics. We recommend a study with sufficient power to compare different CDS formats, and assess the impact of potential covariates on adoption rates and care-planning time.
Keywords: care plans; decision support; standardized nursing terminologies; usability
Keenan, G., Dunn Lopez, K., Yao, Y., Sousa, V., Stifter, J., Febretti, A., Johnson, A., Wilkie, D., Toward meaningful care plan clinical decision support: Feasibility and effects of a simulated pilot study, Nursing Research, vol 66, pp. 388-398, September 1st, 2017. https://doi.org/10.1097/NNR.0000000000000234